CompCare Networx ED A medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Networx ED A
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R

Gap (optional):
  • Varies. See below for specific recommendation for this plan.
Income band:
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Networx ED A
Scheme Benefits: Gap Benefits:
Specialists: 2018 benefits will be posted soon!
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice: 2018 benefits will be posted soon!
  • No benefit
Specialised Radiology: 2018 benefits will be posted soon!
Supplementary Services: (Physio, etc) 2018 benefits will be posted soon!
Transplants: 2018 benefits will be posted soon!
Co-payments:
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals: 2018 benefits will be posted soon!
Casualty: 2018 benefits will be posted soon!
Other: 2018 benefits will be posted soon!
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Networx ED A
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations: 2018 benefits will be posted soon!
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits will be posted soon!
Pathology: 2018 benefits will be posted soon!
General radiology: 2018 benefits will be posted soon!
Specialised radiology: 2018 benefits will be posted soon!
Supplementary Services: (Physio, etc) 2018 benefits will be posted soon!

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Networx ED A
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits will be posted soon!
Consultations: 2018 benefits will be posted soon!
Scans: 2018 benefits will be posted soon!
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Networx ED A
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits will be posted soon!

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Networx ED A
Scheme Benefits Gap benefits
Dentistry: 2018 benefits will be posted soon!
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics: 2018 benefits will be posted soon!
  • No extra benefit available
Maxillo Facial Surgery: 2018 benefits will be posted soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Networx ED A
Scheme Benefits Gap benefits
Chronic: 2018 benefits will be posted soon!
  • No benefit
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid by scheme
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R95 per month
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply and R 280 per discharge
  • No benefit
Biological:

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Networx ED A
Scheme Benefits Gap benefits
Optometry: 2018 benefits will be posted soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Networx ED A
Scheme Benefits Gap benefits
In-hospital: 2018 benefits will be posted soon!
Out-of-hospital: 2018 benefits will be posted soon!
Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Networx ED A
Scheme Benefits Gap benefits
General Appliances: 2018 benefits will be posted soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits will be posted soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits will be posted soon!
  • No benefit
Dialysis: 2018 benefits will be posted soon!
HIV: 2018 benefits will be posted soon!
  • No benefit
Emergency Transport: 2018 benefits will be posted soon!
  • No benefit
International Insurance: 2018 benefits will be posted soon!
  • No benefit
Other: 2018 benefits will be posted soon!

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Networx ED A
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits will be posted soon!
  • No benefit
Pneumonia vaccines: 2018 benefits will be posted soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits will be posted soon!
  • No benefit
Biometric Screening: 2018 benefits will be posted soon!
  • No benefit
Child Immunisation: 2018 benefits will be posted soon!
  • No benefit
Pap Smear: 2018 benefits will be posted soon!
  • No benefit
Mammogram: 2018 benefits will be posted soon!
  • No benefit
PAS Test: 2018 benefits will be posted soon!
  • No benefit
HIV Test: 2018 benefits will be posted soon!
  • No benefit
Other:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Networx ED A
Scheme Benefits Gap benefits
Overal Limit: .
Sub-limits: .

No phone calls!
Our quote will include the right gap cover for this plan


    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised